Clinical introduction An 89-year-old female patient presented to the ED with mild abdominal pain and a history of vomiting for 3 days. Because of dementia, further history was unclear. Vital signs were normal. Clinical examination revealed mild abdominal pain without defence or signs of peritonism. Bowel sounds were normal. Lab results showed a white cell count of 16x10⁹/L, otherwise normal. There was no episode of vomiting during the ED consultation. A supine AXR was performed (figure 1).

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Figure 1

Supine AXR.

What is the diagnosis?

1. Foreign body

2. Gallstone ileus

3. Colon obstruction

4. Intestinal volvulus